The specific aims of this project are: (1) Study the partnership dynamics to determine what factors facilitate improvement and what factors are barriers to improvement; (2) Improve Type II diabetes care across the patients in all partner institutions (3) the Texas Center for Medical Strategy, Training, and Readiness (TC_MEDSTAR) will design, develop, implement, and evaluate a case study to help communities integrate resources for readiness to respond to homeland security needs. The core partners for the first year are four regional primary care clinics in a large, managed care health plan, two family practice residency programs, a large rural clinic with a poor Hispanic population, and a rural and community medicine institute. The third project model is proposed, in which medical conditions and the following core partners are added in a planned sequence during the four years: fourteen additional clinics of the managed care health plan, Driscoll Children's Hospital in south Texas, a northeastern university clinic with a poor African-American population, a large national insurance company in Texas, a large business employer. The performance measures will be introduced at a Summit Conference for the physicians and health care providers from the partner sites. An electronic database will be developed and performance measurement data will be collected by telecommunication links already in place from every partner on a regular basis. Using information technology, the performance measurement data will be analyzed and fed back to the partners. Interactive workshops for all the partners will be held to share successful implementation practices and problems so that peer interaction will cultivate change strategies. Action plans will be made to overcome the identified barriers, as appropriate. Quantitative and qualitative data will be gathered on degree of implementation of performance measures, the impact of implementation on patients, health care providers, and organizations, and the organizational contexts. An estimated 120,000 patients will be directly impacted during the first year and more than 400,000 patients during the four year project. TC-MEDSTAR will disseminate its model nationally through the Air Force and its other partners. Core dissemination plans include meeting presentations, journal publications, development and distribution of education materials such as CD-ROMs and electronic manuals to healthcare providers nationally (physicians, nurses, social workers, etc.).